Provider Demographics
NPI:1275598120
Name:LIVENGOOD, PAUL TAYLOR (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:TAYLOR
Last Name:LIVENGOOD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:912 SETON DR
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-1818
Mailing Address - Country:US
Mailing Address - Phone:301-722-3111
Mailing Address - Fax:301-722-5135
Practice Address - Street 1:912 SETON DR
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1818
Practice Address - Country:US
Practice Address - Phone:301-722-3111
Practice Address - Fax:301-722-5135
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0023774207Q00000X
WV11172207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
104012132OtherCIGNA
MD110098979OtherRAILROAD MEDICARE
MD417071-01OtherBCBS
850290OtherMDIPA - OPTIMUM CHOICE
WV080006019OtherRAILROAD MEDICARE
1266849OtherUNITED HEALTHCARE
WVLI0467843OtherWV MEDICARE PROVIDER NUMBER
WV0056043000Medicaid
MD343101100Medicaid
MDP11372OtherBCBS POS
MDW3990003OtherBCBS FEDERAL
WVW399OtherBCBS FEDERAL PIN #
WV0003OtherBCBS FEDERAL GROUP #
WV00716943OtherBCBS PROVIDER #
1266849OtherUNITED HEALTHCARE
MDP11372OtherBCBS POS